伏立康唑联合两性霉素B治疗侵袭性肺曲霉菌病1例分析
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摘要
对1例伏立康唑联合两性霉素B治疗侵袭性肺曲霉菌病并治愈的病例进行分析,通过查阅文献,探讨抗真菌联合治疗在侵袭性曲霉菌病治疗中的安全性、有效性及合理性。现有研究结果显示,侵袭性曲霉菌病抗真菌联合治疗与单药治疗相比未明确能改善其预后,多烯类药物或三唑类药物联合棘白菌素类药物可能产生协同作用,多烯类药物联合三唑类药物可能产生拮抗作用。侵袭性曲霉菌病抗真菌联合治疗可能导致药物不良反应发生率增高,这与药物的剂量、疗程和特性有关;联合治疗方案由于缺乏充足的临床证据支持,故初始治疗不推荐使用,仅限补救治疗使用。
Analysis a successful case of Voriconazole combined with Amphotericin B in the treatment of invasive pulmonary aspergillosis(IPA), and through consulting literature to study the safety, efficacy and rationality of combination therapyin the treatment of IPA. By consulting literature, the efficacy of combination therapy better than monotherapy are still uncertain. Polyene or triazoles combined with echinocandins maybe synergies, but polyene combined with triazoles maybe antagonisms. Combination therapy maybe increase adverse reaction which related to drug dose and course and properties. In the absence of sufficient clinical evidence,combination therapy is not recommended for initial treatment but as remedial treatment.
Analysis a successful case of Voriconazole combined with Amphotericin B in the treatment of invasive pulmonary aspergillosis(IPA), and through consulting literature to study the safety, efficacy and rationality of combination therapyin the treatment of IPA. By consulting literature, the efficacy of combination therapy better than monotherapy are still uncertain. Polyene or triazoles combined with echinocandins maybe synergies, but polyene combined with triazoles maybe antagonisms. Combination therapy maybe increase adverse reaction which related to drug dose and course and properties. In the absence of sufficient clinical evidence,combination therapy is not recommended for initial treatment but as remedial treatment.
引文
[1]Cadena J,Patterson TF.Invasive aspergillosis:current strategies for diagnosis and management[J].Infect Dis Clin N Amer,2016,30(1):125-142.
[2]Remington TL,Fuller J,Chiu I.Chronic necrotizing pulmonary aspergillosis in a patient with diabetes and marijuana use[J].CMAJ,2015,187(17):1305.
[3]陆薇,梁克诚,卢翠梅,等.COPD合并侵袭性肺曲霉菌病的危险因素及临床特点分析[J].中国临床研究,2016,29(7):892-895.
[4]马丽,陈杭薇,李雪辉,等.肺曲霉菌病的临床研究进展[J].中华医院感染学杂志,2016,26(16):3835-3837.
[5]Perlin DS,Rautemaa-Richardson R,Alastruey-Izquierdo A.The global problem of antifungal resistance:Prevalence,mechanisms,and management[J].Lancet Infect Dis,2017,(17),e383-e392.
[6]田婷婷,周丹青,宋洪涛.几种常用的雾化吸入抗菌药物治疗肺部感染的临床效果评价[J].实用药物与临床,2016,19(7):861-864.
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[8]Te Dorsthorst DTA,Verweij PE,Meis JFGM,et al.In vitro interactions between Amphotericin B,Itraconazole,and Flucytosine against 21 clinical Aspergillus Isolates Determined by Two Drug Interaction Models[J].Antimicrob Agents Chemother,2004,48(6):2007-2013.
[9]Kontoyiannis DP,Boktour M,Hanna H,et al.Itraconazole added to a lipid formulation of Amphotericin B does not improve outcome of primary treatment of invasive aspergillosis[J].Cancer,2010,103(11):2334-2337.
[10]Patterson TF,Thompson GR,Denning DW,et al.Practice guidelines for the diagnosis and management of Aspergillosis:2016 Update by the Infectious Diseases Society of America[J].Clin Infect Dis,2016,63(4):e1-e60.
[11]Caillot D,Thiébaut A,Herbrecht R,et al.Liposomal Amphotericin B in combination with caspofungin for invasive aspergillosis in patients with hematologic malignancies:a randomized pilot study(Combistrat trial)[J].Cancer,2010,110(12):2740-2746.
[12]Raad II,Hanna HA,Boktour M,et al.Novel antifungal agents as salvage therapy for invasive aspergillosis in patients with hematologic malignancies:Posaconazole compared with high-dose lipid formulations of Amphotericin B alone or in combination with caspofungin[J].Leukemia,2008,22(3):496-503.
[13]Mihu CN,Kassis C,Ramos ER,et al.Does combination of lipid formulation of Amphotericin B and echinocandins improve outcome of invasive aspergillosis in hematological malignancy patients?[J].Cancer,2010,116(22):5290-5296.
[14]Marr KA,Schlamm HT,Herbrecht R,et al.Combination antifungal therapy for invasive aspergillosis:A randomized trial[J].Ann Intern Med,2015,(162),81-89.
[15]Raad II,Zakhem AE,Helou GE,et al.Clinical experience of the use of voriconazole,caspofungin or the combination in primary and salvage therapy of invasive aspergillosis in haematological malignancies[J].Int J Antimicrobial Agents,2015,45(3):283-288.
[16]Maertens J,Glasmacher A,Herbrecht R,et al.Multicenter,noncomparative study of caspofungin in combination with other antifungals as salvage therapy in adults with invasive aspergillosis[J].Cancer,2010,107(12):2888-2897.
[17]Garbati MA,Alasmari FA,Altannir MA,et al.The role of combination antifungal therapy in the treatment of invasive aspergillosis:a systematic review[J].Int J Infect Dis,2012,16(2):e76-e81.
[18]Wattier RL,Dvorak CC,Hoffman JA,et al.A Prospective,international cohort study of invasive mold infections in children[J].J Pediatric Infect Dis Soc,2015,(4):313-22.
[19]魏栋,张耀文,陆文岐,等.伏立康唑用药安全性的评价[J].中国临床药理学杂志,2017,33(20):2077-2080.
[20]郎晓琴,夏培元,何菊英,等.1例两性霉素B脂质体治疗肺真菌感染的给药方案分析[J].影像研究与医学应用,2018,2(12):210-212.
[21]梁峰华,孟冬梅,谢慧,等.CYP 2C19基因多态性对侵袭性真菌感染重症患者伏立康唑血药浓度的影响[J].中国医院药学杂志,2015,35(16):1456-1461.
[22]Li X,Yu C,Wang T,et al.Effect of cytochrome P450 2C19polymorphisms on the clinical outcomes of voriconazole:a systematic review and meta-analysis[J].Eur J Clin Pharmacol,2016,72(10):1-9.
[23]刘学松,何为群,陈文英,等.肺部真菌感染患者伏立康唑血药浓度监测的临床应用[J].国际呼吸杂志,2016,36(20):1521-1526.
[2]Remington TL,Fuller J,Chiu I.Chronic necrotizing pulmonary aspergillosis in a patient with diabetes and marijuana use[J].CMAJ,2015,187(17):1305.
[3]陆薇,梁克诚,卢翠梅,等.COPD合并侵袭性肺曲霉菌病的危险因素及临床特点分析[J].中国临床研究,2016,29(7):892-895.
[4]马丽,陈杭薇,李雪辉,等.肺曲霉菌病的临床研究进展[J].中华医院感染学杂志,2016,26(16):3835-3837.
[5]Perlin DS,Rautemaa-Richardson R,Alastruey-Izquierdo A.The global problem of antifungal resistance:Prevalence,mechanisms,and management[J].Lancet Infect Dis,2017,(17),e383-e392.
[6]田婷婷,周丹青,宋洪涛.几种常用的雾化吸入抗菌药物治疗肺部感染的临床效果评价[J].实用药物与临床,2016,19(7):861-864.
[7]Jenks JD,Salzer HJ,Prattes J,et al.Spotlight on isavuconazole in the treatment of invasive aspergillosis and mucormycosis:design,development,and place in therapy[J].Drug Des Devel Ther,2018,12:1033-1044.
[8]Te Dorsthorst DTA,Verweij PE,Meis JFGM,et al.In vitro interactions between Amphotericin B,Itraconazole,and Flucytosine against 21 clinical Aspergillus Isolates Determined by Two Drug Interaction Models[J].Antimicrob Agents Chemother,2004,48(6):2007-2013.
[9]Kontoyiannis DP,Boktour M,Hanna H,et al.Itraconazole added to a lipid formulation of Amphotericin B does not improve outcome of primary treatment of invasive aspergillosis[J].Cancer,2010,103(11):2334-2337.
[10]Patterson TF,Thompson GR,Denning DW,et al.Practice guidelines for the diagnosis and management of Aspergillosis:2016 Update by the Infectious Diseases Society of America[J].Clin Infect Dis,2016,63(4):e1-e60.
[11]Caillot D,Thiébaut A,Herbrecht R,et al.Liposomal Amphotericin B in combination with caspofungin for invasive aspergillosis in patients with hematologic malignancies:a randomized pilot study(Combistrat trial)[J].Cancer,2010,110(12):2740-2746.
[12]Raad II,Hanna HA,Boktour M,et al.Novel antifungal agents as salvage therapy for invasive aspergillosis in patients with hematologic malignancies:Posaconazole compared with high-dose lipid formulations of Amphotericin B alone or in combination with caspofungin[J].Leukemia,2008,22(3):496-503.
[13]Mihu CN,Kassis C,Ramos ER,et al.Does combination of lipid formulation of Amphotericin B and echinocandins improve outcome of invasive aspergillosis in hematological malignancy patients?[J].Cancer,2010,116(22):5290-5296.
[14]Marr KA,Schlamm HT,Herbrecht R,et al.Combination antifungal therapy for invasive aspergillosis:A randomized trial[J].Ann Intern Med,2015,(162),81-89.
[15]Raad II,Zakhem AE,Helou GE,et al.Clinical experience of the use of voriconazole,caspofungin or the combination in primary and salvage therapy of invasive aspergillosis in haematological malignancies[J].Int J Antimicrobial Agents,2015,45(3):283-288.
[16]Maertens J,Glasmacher A,Herbrecht R,et al.Multicenter,noncomparative study of caspofungin in combination with other antifungals as salvage therapy in adults with invasive aspergillosis[J].Cancer,2010,107(12):2888-2897.
[17]Garbati MA,Alasmari FA,Altannir MA,et al.The role of combination antifungal therapy in the treatment of invasive aspergillosis:a systematic review[J].Int J Infect Dis,2012,16(2):e76-e81.
[18]Wattier RL,Dvorak CC,Hoffman JA,et al.A Prospective,international cohort study of invasive mold infections in children[J].J Pediatric Infect Dis Soc,2015,(4):313-22.
[19]魏栋,张耀文,陆文岐,等.伏立康唑用药安全性的评价[J].中国临床药理学杂志,2017,33(20):2077-2080.
[20]郎晓琴,夏培元,何菊英,等.1例两性霉素B脂质体治疗肺真菌感染的给药方案分析[J].影像研究与医学应用,2018,2(12):210-212.
[21]梁峰华,孟冬梅,谢慧,等.CYP 2C19基因多态性对侵袭性真菌感染重症患者伏立康唑血药浓度的影响[J].中国医院药学杂志,2015,35(16):1456-1461.
[22]Li X,Yu C,Wang T,et al.Effect of cytochrome P450 2C19polymorphisms on the clinical outcomes of voriconazole:a systematic review and meta-analysis[J].Eur J Clin Pharmacol,2016,72(10):1-9.
[23]刘学松,何为群,陈文英,等.肺部真菌感染患者伏立康唑血药浓度监测的临床应用[J].国际呼吸杂志,2016,36(20):1521-1526.